Question

Obesity: AZ is a 30-year-old woman who comes to your office seeking help for her weight.   She currently weighs 250 pounds and is 5’6” tall. She admits that her weight is related to poor eating habits. Her diet consists of fast food and highly processed foods (chips, crackers, donuts, candy, etc.). She finds herself eating when she is stressed, eating when bored and eating just because she cannot stop. She describes herself as “being obsessed with food, unable to control her urge to eat when the urge strikes.” She is single and has no children. Her father (age 69) is alive and well with HTN, and hyperlipidemia. Her mother is also alive (age 67) and well with type 2 diabetes, HTN, hyperlipidemia and a history of depression. AZ has a sedentary job at an insurance company. Her company recently offered an incentive for employees who meet certain health goals. She is also aware that her current metabolic status is putting her at risk of diabetes, HTN and hyperlipidemia, all of which run in her family. AZ has tried to lose weight through various dieting techniques (Atkins diet, Weight Watchers, increasing exercise, cutting back on calories, etc.). Her attempts have always been thwarted by her inability to refrain from “feeling the urge to eat all the time.” She is willing to try anything necessary to lose weight and assume a healthier life style. Other than her weight, she is in good health; her labs are within normal limits; physical exam is normal.

1. What therapeutic options exist for this patient? Identify three different options and explain how each works to help the patient lose weight.
2. Which option do you think would be most beneficial for the patient? Explain why.
3. Provide dosing instructions, monitoring parameters, and patient education necessary for the safe use of the selected medication.
4. What other non-pharmacological recommendations would you have for this patient to help her succeed in her weight loss efforts?

Answer 1

a.Some of the therapeutic opinion existing for her to help weight loss are

• Medication :The common diet pills are Orlistat,Lorcaserin,Naltrexone hydrochloride and bupipropion,Liraglutide,Phenteramine and phentaramine and topiramate
  • To stop her craving for food
  • Weight loss medication
  • To prevent any comorbidities like diabetes, hyoertension,depression
• Dietary changes
  • She has to follow a low calorie,low carbohydrate diet.Should avoid fast food and junk food,no refined foods,no white sugar,chocolates etc.,
  • Follow diet which are nutrious healthy like brown rice,olive oil,fruits, vegetables, nuts,grains,cereals, pulses
• Exercise
  • Should so regular daily exercise atleast an hour
  • Aerobic exervise are good

b.The patient is in need of a medication treatment because the patient seems to have obsession with food and as the leading cause of obesity.A medication which can reduce her appetite and help her to loose weight should be prescribed .Her BMI is 39.1 which can be treated only with medication .The patient can be prescribed Phentermine and Topiramate drug. It helps to control appetite, makes one feel full stomach and aide weight loss by burning calories and making one to dislike foods

c.Dosing instruction

3.75 mg to 23 mg /day in initial stage for 2 weeks

Followed by maintainace dose of 7.5 mg to 46 mg once a day

Monitoring

• Note for decreaed appetite
• Assess any adverse effects
• Weight should be reduced at least by 3% after 12 weeks
• Monitor all blood parameters before starting the drug
• Make sure the pregnancy test is negative

Patient education :

• To be taken as prescribed by doctor
• No alcohol,smoking,driving
• Take once in morning, if missed the dose,don't take it ,wait for the next dose
• No OTC
• Report in case of planning for pregnancy
• Do not stop the mefication abruptly or with out a doctors concession

4.The other non pharmacological treatment are

• Dietary changes
• Exercise
• Psychological support to stick to the regimen